Twisting Without Shouting

Does the very word yoga conjure up intimidating images of lithe young things contorting their bodies into various pretzel-inspired—and painful-looking—positions?

That's what I was worried about when I joined a yoga class at my gym a decade or so ago. But curiosity won out, and I plopped down on a mat, ready for some serious hurt. And sure, I was pretty sore for a few days afterwards (some of that pretzel stuff is for real!), but there was much more light stretching and deep breathing than I expected, and in the end I mostly felt energized and renewed.

I also wanted more.

There are many different forms and styles of yoga, an ancient holistic health practice originating in India that typically includes body poses, breathing exercises, and some form of meditation. It can be adapted for people with all body types and health conditions. "Yoga is for everyone—all you need to practice is to be conscious and to be able to breathe," says Carol Krucoff, RYT, a yoga therapist at Duke Integrative Medicine in Durham, N.C., and coauthor of Healing Moves: How to Cure, Relieve and Prevent Common Ailments with Exercise. Krucoff has created individualized yoga routines for people with diabetes and advanced heart failure, for example, as well as those confined to wheelchairs. "So often I hear people say 'I'm not flexible enough to practice yoga,'â" says Krucoff. "To me, that's like saying 'My house is too messy to hire someone to come clean it.' If you're not flexible, yoga will help you become more flexible."

There are many other health benefits, as well, says Timothy McCall, MD, author of Yoga as Medicine: The Yogic Prescription for Health and Healing. He says that a regular yoga practice can stretch and strengthen muscles; fortify bones; improve balance; boost heart and lung efficiency; and help you lose weight and reduce body fat.

A small but growing number of studies also show that yoga can have a positive impact on diabetes. For example, a small trial of type 2 patients from London's Yoga Biomedical Trust found that a 12-week yoga program helped reduce fasting blood glucose and hemoglobin A1C levels; the much larger Medicare Demonstration Project, which tracked more than 2,000 people with heart disease who did yoga and made other lifestyle changes for a year, saw similar results in participants who had diabetes, after both 12 weeks and 1 year.

In addition, researchers at the University College of Medical Sciences in Delhi, India, have found, through various studies, that daily yoga classes can decrease fasting blood glucose, blood glucose after meals, hemoglobin A1C, systolic and diastolic blood pressure, and also improve insulin resistance. Finally, McCall points out that yoga can improve the distribution of weight on the feet, which is essential for those at risk for ulcerations. In addition to its many physical benefits, yoga can have a huge impact on your psyche. "Yoga is probably the best overall system of stress reduction that's ever been invented, and stress definitely plays a role in type 2 diabetes," says McCall. Still, before you get down with Down Dog, it's wise to get the go-ahead from your regular doctor and an ophthalmologist. Then do some homework. "There are many, many styles and kinds of yoga out there, ranging from extremely gentle practices to very vigorous practices done in a heated room," says Krucoff. "I caution people with diabetes to look for a beginner's level or gentle yoga practice. You definitely want to start slowly and progress gradually." Wear comfortable exercise clothing, bring your own mat if you have one (most studios and gyms will have ones you can use, but there is some risk of transmitting infection with shared mats), and be prepared to take off your shoes and socks (yoga is usually performed barefoot, but if you have foot issues, consult your doctor). You might also want to bring a towel, to cushion your knees for some poses. And don't worry if you have to stop in the middle of class, or if you just want to sit down on your mat and take a couple minutes' break. Good yoga teachers will always encourage you to go at your own pace.

Indeed, it's key to find the best possible instructor. Some quick tips:

Qualifications. Look for someone who's been teaching yoga for at least two to three years, and who's been practicing for at least five years. Accreditation is a big plus; the Yoga Alliance's registered yoga teacher, or RYT, stamp signifies a minimum of 200 hours of training from a single school.

Experience. Try to find an instructor who is at least familiar with diabetes and its contra­indications and, ideally, who has worked with other patients before. Since overweight people are at much greater risk for yoga-related injuries, seek a teacher who has experience working with heavier clients, if applicable. No matter whom you choose, make sure he or she knows about your diabetes and any related complications or concerns, so you get the best, safest practice possible.

While a regular yoga class at your local gym or studio is fine if you're relatively healthy, people with problems like neuropathies of the feet or who are obese may benefit more from a private, one-on-one, or small specialized group session—at least to start, says McCall. He recommends developing, along with an instructor, an individually tailored routine of, say, 10 or 20 minutes, which can eventually be done on your own, at home, and preferably daily. "It's safer, and, in terms of creating new [life] patterns, I think practicing every day is way more effective than a one-hour class," says McCall. "I think regular home practice is really the key to the transformational power of yoga."

If you're ready to get going, try the simple beginner's program of five exercises designed by Carol Krucoff, on page 32. Ideally, it's not meant to replace regular aerobic activity like walking, she says, but it will add important strengthening, flexibility, and stress- reduction components to your fitness routine. Take it from me: While I was working on this month's column (after nearly two years away from my own regular yoga practice) I did this basic routine every morning before my 2-year-old son woke up. It felt so good—and helped clear my head so much better than my usual five cups of coffee!—that I fully intend to keep doing it. Don't be surprised if, once you get started, you want more, too.

Carolyn Butler has written for the Washington Post and the New York Times, among other publications.

Yoga for Diabetes: An Everyday Routine

Here's a basic and gentle set of yoga exercises designed by Carol Krucoff, RYT. Aim to do the routine every day, if possible. Yoga is typically done barefoot, but if you have neuropathy or other foot concerns, consult your doctor about possibly using socks or other footwear.

1. Deep Abdominal Breathing (Yoga "3-Part" Breath)

(relaxes and calms)

Lie down with knees bent and feet flat on the floor or sit in a chair. Place your hands on your lower belly—just above your pubic bone and below your navel. (If you are sitting, drop your "sit bones" into the chair and lengthen up through the crown of your head, to extend your spine.) Inhale deeply through your nose, so that your abdomen expands against your hands. Exhale completely, and feel your hands rest back. Repeat for two or three breaths. Now, move your hands to your rib cage. On the inhalation, feel your ribs expand out to the side. On the exhalation, feel them relax back. You're still bringing air into the lowest portion of the lungs, so that your belly rounds, but now you're also expanding the middle portion. Finally, move your hands up under your collarbone and feel the movement of breath in this uppermost portion of the lungs. Relax your arms by your sides and practice this complete, three-part breath: Inhale deeply so that your belly rounds, then your rib cage expands out to the sides, then fill up under the collarbones. On the exhalation, release all the old, used air so that everything softens and rest back into the support of the floor or chair. Repeat for several breaths.

2. Knees-to Chest Pose

(stretches back, helps digestion)

Lie on your back with knees bent, feet flat on the floor. Inhale deeply, then exhale and hug your right knee into your chest, keeping your neck and shoulders relaxed. (You can use a yoga strap or other strip of material, like a necktie, to catch your leg if it's a strain to use your hands.) Bring your awareness to your right hip and think about it softening so that, as you exhale, you can hug your right thigh even closer to your rib cage. Continuing to hug your knee to your chest, make some slow, easy circles with your right foot—imagine your big toe is a crayon as you draw circles in the air in both directions, clockwise and counter-clockwise. Relax the foot, then slide your hands behind your right thigh and inhale your right leg up toward the sky, straightening the leg as much as you comfortably can. Flex your foot so that your heel extends to the sky and your toes point back toward your nose. Then point your toes to the sky. Flex and point a few more times, then hug your knee back to your chest and repeat with the left leg.

3. Cat-Dog Tilt

(stretches and strengthens back, strengthens arms)

Come onto your hands and knees, with your wrists directly under your shoulders and your knees under your hips. Fan your fingers out wide, with your middle finger pointing forward. (If this hurts your wrists, place your hands in a fist and place the top of the fists on the floor.) Let your spine be in "neutral"—"table top" pose with a flat back. Tune in to your breath. Lengthen the crown of your head toward the front of the room and your tailbone toward the back of the room so your spine extends as much as possible. Inhale completely and on exhalation, arch your back up like an angry cat bringing your nose in toward your navel, and pressing into the floor with your palms, but keeping your elbows soft. On inhalation, reverse the curve so your tailbone comes up and you gaze upward as your spine arches down, like a hammock. Repeat several times at your own pace, exhaling as you arch your back up to cat, inhaling as you reverse the curve to dog tilt. Imagine that your spine is a string of pearls, so that you move each pearl individually, with the breath.

4. Mountain Pose

(strengthens legs, improves posture)

Stand with your feet hip-width apart, and distribute your weight evenly onto the soles of your feet. Be sure to press evenly into all four "corners" of the feet—pressing down at the ball of the big toe and of the pinkie toe and of the inner and outer heels. Activate your leg muscles, drawing your knees over your ankles and your hips over your knees. Lengthen your spine by extending up from the top of your head and bringing your shoulders over your hips and your ears over your shoulders, chin parallel to the ground. Breathe deeply as you relax your shoulders away from your ears and release any tension in your face and throat. Gaze softly toward the horizon. Variation: On an inhalation, raise your arms up toward the sky. On an exhalation, relax them back down. Repeat several times, moving with the breath.

5. Warrior One

Carol Krucoff, RYT, is a yoga therapist at Duke Integrative Medicine in Durham, N.C., and coauthor, with her husband Mitchell Krucoff, MD, of Healing Moves: How to Cure, Relieve and Prevent Common Ailments with Exercise. For more information, visit her Web site: www.healingmoves.com.

(strengthens legs, enhances balance)

Stand tall in Mountain Pose with your hands on your hips. Step your right foot straight forward a comfortable distance ahead of you. Turn the toes of your left foot out slightly. Inhale and lengthen through the crown of your head, then exhale and bend your right knee so that the knee moves out directly over the toes. If you feel steady, release your arms down by your sides, then inhale them overhead, shoulders relaxed and palms facing in. Relax your face and throat. If it feels too strenuous to keep your arms up, place your palms together at your chest in prayer position. Stay in Warrior for several breaths, then step back and repeat on the other side.